Surely you’ve read before (perhaps even in our publication) about the challenges of Boomers and younger generations working together. You know the drill– these young’uns are good with computers but they’re all hung up on this idea that they should get to have a life. But Cam Marston, the opening speaker at MGMA put a new spin on the concept– addressing how generational differences can affect the way that you attract, and treat, patients.

A lot of it is pretty obvious. Millennials (those born between 1980 and 2000) like getting information by text, Boomers not so much. Younger patients do a lot more of their own internet research.

But some of the advice on how to act on these generations’ well-known differences was Read more »

With all the talk about how EMR/EHR resources will make practicing medicine better, faster and safer, I learned of an unintended consequence that is probably under appreciated these days. Hospitalists are being asked to admit more and more patients because, for primary care doctors, when they compare EMR medicine with the old way of doing things, EMR is just too time consuming to make it worth their effort.

That’s right, hospitalists are admitting more patients because the primary care doctors find their time costs for navigating their new EMR, which they bought to qualify for EHR stimulus funds under ARRA, are simply too great. In a business where efficiency must prevail, EHRs Read more »

How many patients should a hospitalist average on any given day? What do you think? The Hospitalist asked that question to hospitalists and 421 of them responded. They were given responses in quintiles of 10 or fewer, 11-15, 16-20, 21-25, and more than 25 total patient encounters per day.

Go check out their results. I’m not surprised. But, as they say, there is no right answer. The right number is the number that brings WIN-WIN-WIN-WIN to the patient-doctor-hospital-insurance quadrangle. WIN-WIN-WIN-WIN is possible. It just takes a great understanding of removing the barriers to efficiency. Efficiency and quality of care can move in the same direction. They don’t have to be opposing forces. You can be better and faster if given the tools, whether those tools are driven by IT support, systems process changes, communication enhancement, physical and structural hospital layout changes or documentation support tools. There are many others. Read more »

Mechanism Design has demonstrated that the most efficient systems are created when everyone’s vested interests are aligned.

“An example is defense contracting. If you agree to pay on a cost plus basis you have created incentive for the contractor to be inefficient.

The defense contractor will build enough extra into a fixed price system to account for cost overruns. The cost overrun would be permitted in the rules if the price was transparent. If there were no cost overruns the contractor’s profit would be increased. It would provide incentive to be efficient.

“If you agree to pay a fixed price, you can come close to an efficient price if you have all the truthful information.”

A reader wrote,

Stanley:

History has proven over and over again that only the market mechanism of willing sellers and willing buyers is the optimal way to allocate economic resources. This presumes an informed buyer, and a willingness of sellers to compete for buyers. Adam Smith was clear on this in the Wealth of Nations.

If incentives are aligned and truthful price information is available an efficient system is created. Most stakeholders think they can do better by not sharing truthful information. If the rules of the game require truthful information the system can become an efficient market driven solution.

The healthcare system must become market driven. At present Read more »

Last week, Medicare’s Center for Medicare and Medicaid Innovation announced a Comprehensive Primary Care (CPC) Initiative, which asks private payers and state Medicaid programs to join with Medicare to “help doctors work with patients to ensure they:

according to an email from CMS’s press office. The initiative will provide qualified practices with risk-adjusted, per patient per month care managements payments, in addition to traditional fee-for-service payments, along with the opportunity to share in savings achieved at the community level.

I believe that the Initiative is a potential game-changer in helping to support and sustain primary care in the United States. But Read more »

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